(2014 state that models and strategies to develop the throughput of emergency department patients have usually ignored the way individual staff create patient flow, and the organisational approach to these demands. The creation of a hospital-wide patient flow team with people from different departments to manage the modification is necessary to implement patient flow changes that will eliminate emergency department overcrowding (Wilson and Nguyen 2004). However, it is still an important function of empirical sociological research to give evidence that supports or challenges common sense hypotheses in terms of management and leadership; solutions to ED overcrowding and boarding require policies and programs to transform culture rather than depending on appeals to efficiency imperatives alone (Nugus et al. 2014).
Hospitals are slow to implement changes, and, despite many efforts, scientific knowledge remains limited on which strategies and systematic models can actually improve patient flow in EDs. It is currently unknown which strategies provide the best solutions to patient flow in the ED (Eitel et al. 2010). Increasing demand for ED services impels researchers to look carefully at ED patient loads and crowding, with further cooperation between emergency medicine researchers and operations management experts to develop the available methods (Wiler, Griffey and Olsen 2011). Thus, Lean Six Sigma strategy will fill the